<div id="afspraak_form" style="display:none;"><div id="af">
<table ><tr ><td><label for="naam" class="afspraak_label">Naam:</label></td></tr>
    <tr ><td><select id="aanhef" name="aanhef" class="afspraak_input">
                <option value="Dhr." selected="selected">Dhr.</option>
                <option value="Mevr.">Mevr.</option>
            </select><input type="text" name="naam" id="naam" class="afspraak_input name_input"/></td></tr>
            <tr ><td> <label for="email" class="afspraak_label">Email:</label></td></tr>
            <tr ><td><input type="text" name="email" id="email" class="afspraak_input" /></td></tr>
             <tr ><td> <label for="onderwrep" class="afspraak_label">Onderwerp:</label></td></tr>
            <tr ><td><input type="text" name="onderwerp" id="onderwerp" class="afspraak_input" /></td></tr>
            <tr><td><label for="filiaal" class="afspraak_label">Filiaal: </label></td></tr>
            <tr><td><select id="filiaal" name="filiaal" class="afspraak_input fil_input">
                <option value="Den Haag" selected="selected">Semra Mode Den Haag</option>
                <option value="Rotterdam">Semra Mode Rotterdam</option>
            </select>
                </td></tr>
             <tr ><td> <label for="bericht" class="afspraak_label">Bericht:</label></td></tr>
            <tr ><td><textarea name="bericht" id="bericht" cols="40" rows="6" class="afspraak_input"></textarea></td></tr>
            <?php if(isset($product)):?>
            <input type="hidden" name="product" id="product" value="<?php echo $product;?>" />
            <?php endif;?>
        </table>
   <a href="javascript:void(0);" onclick="sendForm('#afspraak', ''); " class="afspraak_button"><img src="/images/afspraak_button.png" alt="Semra mode afspraak maken"/></a>
    </div>
<div id="afspraak_succes" />
</div></div>


